Medical device interface system with automatic rate threshold adjustment

ABSTRACT

An external programming system and method for implantable medical devices (IMDs) is disclosed. The external programming system includes a communication circuit, a display device, an input device, and a processor. The communication circuit is configured to link to an IMD to transmit or monitor IMD timing parameter settings. The display device is configured to display a textual representation of an IMD timing parameter setting and a specified IMD timing parameter limit, a graphical slide control comprising a movable feature indicating the IMD timing parameter setting, a graphical slide-control limit corresponding to the specified IMD timing parameter limit, and a graphical representation of physiologic information including a portion of said graphical representation aligned with the slide control movable feature. The input device is configured to adjust the movable feature in response to user input. The processor is configured to monitor or store an IMD timing parameter setting.

RELATED APPLICATIONS

This application is a divisional of U.S. application Ser. No.10/841,966, filed on May 6, 2004, now U.S. Pat. No. 7,272,444, whichapplication is incorporated herein by reference, which claims thebenefit of provisional application U.S. Ser. No. 60/468,946 filed on May7, 2003, entitled “MEDICAL DEVICE INTERFACE SYSTEM AND METHOD”, Petersonet al.

FIELD OF INVENTION

The present invention relates to programming devices used to programimplantable programmable medical devices, such ascardioverter-defibrillators and pacemakers. More particularly, but notby way of limitation, the present invention relates to improvements inthe graphical user interface of the programmer devices, wherein thegraphical user interface automatically communicates to the programmingdevice user in real-time suggested changes in parameters in response tothe user's modification of related parameters. The programming devicegraphical user interface improvements also include a method ofpreventing parameter modification that creates unsafe conditions.

BACKGROUND OF THE INVENTION

Implantable cardiac rhythm CRM devices, more specifically, cardiacdefibrillators (ICDs) are well established therapeutic devices fortreating patients who have experienced one or more documented episodesof hemodynamically significant ventricular tachycardia or ventricularfibrillation. Since their clinical inception more than two decades ago,ICDs have evolved from basic to sophisticated electronic devices thatprovide physicians with a variety of clinically useful functions withwhich to treat patients.

Presently, even the most basic ICDs typically have more than onetachycardia detection criterion, tiered therapy which combinesbradycardia support pacing with various antitachycardia pacing modes,low-energy cardioversion, defibrillation, and data logging capabilities.The data logging capabilities within ICDs have become increasinglyimportant, since the amount of data required for the ICDs operationincreases proportionally with the increase in ICD functions. Efficientlyprocessing this large amount of data has become possible with theincorporation of microprocessors and memory with the ICD.

Once an ICD has been implanted, the physician interacts with the ICDthrough a clinical programmer. The clinical programmer is used toestablish a telemetric link with the implanted ICD. The telemetric linkallows for instructions to be sent to the electronic circuitry of theICD and clinical data regarding the occurrence and treatment of apatient's cardiac arrhythmias and the ICD's operation to be sent fromthe electronic circuitry of the ICD to the programmer. The typicalprogrammer is a microprocessor based unit that has a wand for creatingthe telemetric link between the implanted ICD and the programmer, and agraphics display screen that presents a patient's recorded cardiac dataand ICD system information to the physician.

As ICD feature sets become richer and more complex, ICDs are gettingincreasingly more complicated to program. This is especially the case insituations where modifications of one feature ripples through andinteracts with other selected features.

For ICDs it can be very difficult for physicians to deal withnon-compatibilities with programming. Such devices may have manyfeatures to program and, when physicians go in to program, there may besome inconsistencies that are not recommended by logic or by concernsfor safety of the patient. In the past, these inconsistencies weredisplayed as error messages and the physician often had to wade througha series of screens to determine the nature of the inconsistency and howto resolve it.

In addition, physicians were frustrated by error messages, which note aninteraction but did not tell them what to do resolve the problem. Theywere often reduced to trial and error programming which might create asecond parameter interaction while resolving the first.

In addition, for devices currently on the market, device parameters areset by selecting from a list of possible options via the programmer. Theoptions have typically been scattered throughout the programmer userinterface.

What is needed is a more intuitive way for the physician to resolveparameter interactions and a user interface that allows relatedparameters to be displayed simultaneously to enhance physicianresolution of such parameter interaction conflicts.

SUMMARY OF THE INVENTION

A medical device system having a medical device and a programminginterface, wherein the programming interface provides a method ofautomatically adjusting parameters to be programmed to a medical devicein direct response to a user modifying related parameters that are to beprogrammed to the medical device. The programming interface is comprisedof a graphical user interface including slide controllers that areengaged on the display screen by the system user to graphically modifyrelated parameters on screen. In response to the on screen parameterchanges implemented by the user via slide controller movement, theprogrammer automatically adjusts related parameters on the displayscreen by moving slide controllers for related parameters. Thisautomatic adjustment by the programmer graphically illustrates to theuser the automatic adjustments being made to the related parameters,which thereby prevent the creation of unsafe conditions. The automaticadjustment also graphically illustrates the relationship betweenparameters being adjusted by the programmer user and the relatedparameters that are automatically adjusted by the programmer. Inresponse to on screen parameter changes, the system graphicallyillustrates the parameter values that are changed and those that areprogrammed to the medical device and those that would cause unsafecondition in the medical device if programmed.

These and various other features, as well as advantages, whichcharacterize the present invention, will be apparent from a reading ofthe following detailed description and a review of the drawings.

BRIEF DESCRIPTION OF THE DRAWINGS

In the drawings, which are not necessarily drawn to scale, like numeralsdescribe substantially similar components throughout the several views.Like numerals having different letter suffixes represent differentinstances of substantially similar components. The drawings illustrategenerally, by way of example, but not by way of limitation, variousembodiments discussed in the present document.

FIG. 1 is an embodiment of an implantable cardiac defibrillatorimplanted into a heart of a patient, from which portions have beenremoved to show detail;

FIG. 2 illustrates a perspective view of an external programming unitaccording to one embodiment of the present invention that is used forcommunicating with the defibrillator of FIG. 1;

FIG. 3 illustrates one embodiment of an implantable cardiacdefibrillator medical device system according to the present invention;

FIG. 4 illustrates one embodiment of a display of a graphical userinterface of the external programming unit of FIG. 3 for use in settingand adjusting rate thresholds of an implantable cardiac defibrillator;

FIG. 5 illustrates one embodiment of a display of a graphical userinterface of the external programming unit of FIG. 3 for use inadjusting and visualizing device timing of an implantable cardiacdefibrillator; and

FIG. 6 illustrates one embodiment of a display of a graphical userinterface of the external programming unit of FIG. 3 for use inadjusting and visualizing device timing of an implantable cardiacdefibrillator.

DETAILED DESCRIPTION OF THE PREFERRED EMBODIMENT

In the following detailed description, reference is made to theaccompanying drawings that form a part hereof, and in which is shown byway of illustration specific embodiments or examples. These embodimentsmay be combined, other embodiments may be utilized, and structural,logical and electrical changes may be made without departing from thespirit and scope of the present invention. The following detaileddescription is therefore, not to be taken in a limiting sense, and thescope of the present invention is defined by the appended claims andtheir equivalents.

The present invention is an improved graphical user interface of aprogrammer used within a medical device system, wherein the medicaldevice system is comprised of a medical device and a medical deviceprogrammer. The medical device programmer provides a method forautomatically adjusting rate threshold parameters to be programmed to amedical device in direct response to a user modifying related ratethreshold parameters that are to be programmed to the medical device.The programmer graphical user interface utilizes slide controllers thatare engaged on the display screen by the system user to modify ratethreshold parameters. In response to the on screen rate thresholdparameter adjustments implemented by the user via slide controllermovement or engaging a pop-up menu that includes a plurality of numbersthat are displayed upon engagement of the rate control window withineach slide controller. The programmer automatically adjusts related ratethreshold parameters on the display screen by automatically moving slidecontrollers for related threshold parameters. This automatic adjustmentby the programmer graphically illustrates to the user the automaticadjustments being made to the related rate threshold parameters by theprogrammer. The automatic responsive adjustment function that adjustsrelated rate threshold parameters in response to user parameteradjustments is controlled by programmer rules that dictate levels andranges for related threshold rates so as to prevent the creation ofunsafe conditions caused by conflicts in the parameters. The automaticresponsive adjustment function also graphically illustrates therelationship between rate threshold parameters being adjusted by theprogrammer user and the related rate threshold parameters that areautomatically adjusted by the programmer.

Another aspect provided by the improved graphical user interface is theability of the programmer to provide for the graphical setting,adjusting and visualizing of device timing behavior. The improvedgraphical user interface provides the programmer user with the abilityto graphically communicate how cardiac conditions relate to particularparameters as the user adjusts parameters such as Atrioventricular delay(AV delay), left ventricular offset (LV offset), post-ventricular atrialrefractory period (PVARP) right ventricular refractory period (RVRP),and left ventricular refractory period (LVRP). It also allows theprogrammer user with the ability to graphically resolve potentiallyunsafe conditions and undesirable states resulting from the adjustmentof parameters. It further allows the user to visualize the graphicrelationship between timing parameters such as AV delay, LV offset,PVARP, RVRP and LVRP while facilitating the user's ability tographically adjust the atrial and ventricular timing settings usingparameter control sliders. It also uses color codes to illustrate therelationship between different atrial and ventricular timing settings.

The present system and methods are described with respect to implantablecardiac rhythm management (CRM) devices, such as pacemakers,cardioverter defibrillators (ICDs), pacer/defibrillators, andmulti-chamber and/or multi-site (in a single chamber or multiplechambers) cardiac resynchronization therapy (CRT) devices that utilizestandard pacing and defibrillating leads. Notwithstanding, it iscontemplated that the present invention and methods may be used inalternative embodiments with CRM devices that are not using standardpacing and defibrillating leads or with CRM devices that are leadless.

FIG. 1 illustrates a medical device system 10 including a medical deviceprogrammer 12 and a medical device 20. The programmer 12 includes aprocessor, memory and a program module for controlling an improvedgraphical user interface feature that allows a user to adjusts ratethresholds while graphically illustrating the relationship between therate thresholds the user changed and rate thresholds that areautomatically changed by the programmer in response to the ratethreshold adjustments made by the user. The programmer 12, illustratedin FIG. 2 also includes an input device 14 and a display 18 and isconnected to a medical device via communications link 34, as shown inFIG. 1. In the present embodiment, the communications link 34 isestablished by the programmer's telemetry system 30 and the medicaldevice's telemetry system 32. In one embodiment, the medical devicesystem is an implantable shock therapy system. An example of such asystem is shown in FIG. 3. Medical device 20 generally includes itscontrol unit 20 and implantable leads 22 and 24, coupled to the unit 20.The leads 22 and 24 are, in turn, introduced into the heart 50, asdescribed below. As also described in more detail below, the medicaldevice 20 may be implanted or may be used as an external device.

The implantable leads 22 and 24 may comprise elongated bodies, having aproximal end 28 and 26, respectively, and a distal end 60 and 64,respectively. The implantable leads 22 and 24 may include one or moreacceleration sensor units 66, respectively, and may further include oneor more pacing/sensing electrodes 68 and 70, respectively. Theelectrodes 68 and 70 can be used to sense electrical activity or provideelectrical stimulation to the heart tissue adjacent to the electrodes

Each lead 22 and 24 has an inner lumen 25 and 27, and the accelerationsensor unit 66 may be positioned within the lumens 25 and 27 of eachlead. A suitable lead for this purpose is the easy track from GuidantCorporation. Suitable miniaturization accelerometers having a diameterof approximately 1 millimeter available from Ball Semiconductor, Inc.(see U.S. Pat. No. 6,197,610) and others, and these miniaturizationaccelerometers may be positioned within the inner lumen of the easytrack lead and positioned adjacent the lead electrode after the lead hasbeen properly positioned on or within the heart 500. Accelerometer(s)may be positioned in the lumen of the lead within the coronary sinusvein, if desired, thereby minimizing the invasiveness of theaccelerometer implantation.

As illustrated in FIG. 2, the programmer 12 includes an input device 14such as a touch screen pen or mouse, a display 18 and a telemetrysystem. Features and threshold parameters selected or programmed byphysicians into programmer 12 are communicated through telemetry link 30to the medical device 20 via communication link 32, as illustrated inFIG. 1. The medical device 20 controls how shock and pacing therapy areapplied to the patient's heart.

Programmer 12 includes an automatic responsive adjustment function thatadjusts related rate threshold parameters of CRM devices whilegraphically illustrating the relationship between the rate thresholdsadjustments on the programmer display 18. The method implemented byprogrammer 12 provides a user with a means to graphically modify ratethresholds while the programmer itself processes each rate thresholdchange and automatically modifies related parameters that need to bechanged in order to prevent conflicts among related parameters whenchanges are made.

In one embodiment, the programmer's automatic responsive adjustmentfunction and an interactive programming feedback feature are designed toassist the user in programming the medical device appropriately. In onesuch embodiment, a set of rules governs the number of possibilities thatthe various parameters may be programmed to. The rules ensure thatincompatibilities among features are identified and prevented and thatprogramming conflicts cannot exist. In one such embodiment, if a userattempts to program a parameter in such a way that may causeincompatibility among features, the programmer 12 automatic responsiveadjustment function and interactive programming feedback featureautomatically modifies related parameters that need to be changed inorder to prevent conflicts in the parameters. In addition, because theprogramming interface is graphical, the programming interface provides avisual indication on the respective programmer display 18 that informsthe user of the changes being made to parameters being changed by theuser. It also provides a visual indication on the respective display 18that informs the user of the automatic changes that occur with relatedparameters automatically modified in response to the changes being madeto selected parameters by the user. The programmer automatically causeschanges in related parameters so that the medical device parameter setsremain clear of conflicts.

In some instances, parameter modifications that may cause programmingconflicts are not automatically modified by the programmer automaticresponsive adjustment function. Under this circumstance, the interactiveprogramming feedback function provides a visual indication on therespective display that informs the user of the programming conflictbetween parameters.

A graphical user interface display, which includes the automaticresponsive adjustment function and interactive programming feedbackfeature may be used to set and adjust rate thresholds in ICDs anddefibrillators, is shown in FIG. 4. The display shown in FIG. 4 isgeared toward the defibrillator system shown in FIG. 1 but can begeneralized to control any medical device 20. In the embodiment shown inFIG. 4, the graphical user interface display illustrates that theprogrammer interface includes seven rate grabbers, VentricularFibrillation (VF), Ventricular Tachycardia (VT), Ventricular Tachycardia(VT-1), Atrial Fibrillation (AF), Maximum Sensor Rate (MSR), MaximumTracking Rate (MTR) and Lower Rate Limit (LRL). Of the seven rategrabbers, three of them are in the ventricle zone (VF, VT, VT-1) and oneof them AF is in the atrial zone. In this embodiment, the threeventricular zones (VF, VT, VT-1) and the single atrial zone (AF) aretachyarrhythmia zones. The graphical user interface 100 allows thenumber of zones in the ventricles to be modified and selectively toggledbetween single zone, dual zone and three zones. This feature isaccomplished by the interactive ventricle zone button 116, which allowsfor the selection of the number of ventricle zones ranging from one tothree. In the present embodiment, a single zone ventricle configurationwould comprise a VF zone, and a dual zone ventricle configuration wouldcomprise VF and VT zones. It is to be understood that the invention canuse any number of rate grabbers. For example, an alternative embodimentmay include more or less than seven rate grabbers. If eight rategrabbers are used in an alternative embodiment, the seven rate grabberspreviously identified and are utilized along with an AT rate grabber.

Interface for Setting and Adjusting Rate Thresholds

As illustrated in FIG. 4, each ventricular zone is identified on display100 by colored windows 120, 124, and 128, which are all differentcolors. Colored window 120 represents the VF zone. Colored window 124represents the VT zone, and colored window 128 represents the VT-1 zone.Adjacent to the edge of each colored window 120, 124, and 128 areparameter slide controllers 122, 126 and 130. Parameter slidecontrollers 122, 126 and 130 are the graphical control mechanisms thatthe system user engages to control threshold settings for VT-1, VT andVF. In the embodiment shown in FIG. 4 the threshold rate for VT-1 is 125bpm, the threshold rate for VT is 145 BPM and the threshold rate for VFis 165 BPM. The threshold rates for VT-1, VT and VF (125 BPM, 145 BPMand 165 BPM) are illustrated in the rate windows on parameter slidecontrollers 122, 126 and 130. The rate windows of the slide controllers(VT) 122, (VF) 126, (VT-1) 130, (AF) 142, (MSR) 134, (MTR) 140, and(LRL) 136 has a white background that indicates to the user that thethreshold rates illustrated in the slide controller rate windows arethreshold rates currently programmed in the medical device. Thethreshold rates within the rate windows on parameter slide controllers122, 126 and 130 are modified by sliding the parameter slide controllers122, 126 and 130 up and down vertically. When threshold rates areadjusted, the background of the slide controller rate window changes toa different color to indicate that the threshold rate illustrated in thewindow is a proposed rate that has not be programmed. In the presentembodiment, the background of the slide controller rate window changesto green to illustrate that a threshold rate adjustment has been made.It is to be understood that the background or the actual text within theslide controller rate window may be changed to any color so long as thecolors indicate that the rates have been adjusted. In addition to thebackground of the slide controllers (VT) 122, (VF) 126, (VT-1) 130, (AF)142, (MSR) 134, (MTR) 140, and (LRL) 136 changing to a different colorwhen the threshold rates for VT, VF, VT-1, AF, MSR, MTR and LRL areadjusted, the threshold rates for VT, VF, VT-1, AF, MSR, MTR and LRLprogrammed into the medical device (the threshold rate displayed in theslide controller prior to modification) are displayed in parenthesis inclose proximity to the slide controller to illustrate to the user thethreshold rate currently programmed into the medical device.

Movement of parameter slide controllers 122, 126 and 130 verticallyupward causes threshold settings for VT-1, VT and VF to be increased andsuch increase is reflected within the rate control windows on theparameter slide controllers 122, 126 and 130. Movement of parameterslide controllers 122, 126 and 130 vertically upward also causes thesize of the colored windows 120, 124 and 128 to be decreased or remainthe same. Movement of parameter slide controllers 122, 126 and 130vertically downward causes threshold settings for VT-1, VT and VF to bedecreased and such decrease is reflected within the rate windows on theparameter slide controllers 122, 126 and 130. It also causes the size ofthe colored windows 120, 124 and 128 to be increased or remain the same.If the parameter slide controller 130 is adjusted by the system user orautomatically in response to the automatic responsive adjustmentfunction whereby the threshold rate of VT-1 is reduced to a rate that iswithin a predetermined range of the maximum sensor rate or maximumtracking rate thresholds displayed, the automatic responsive adjustmentfunction causes automatic adjustment of the maximum sensor rate and/ormaximum tracking rate via parameter slider controllers 134 and 140. Inthe present embodiment, the predetermined range is 5 Bpm in accordancewith programmer rules that require a range of at least 5 Bpm between thethreshold rate of VT-1 and the thresholds for the maximum sensor rateand maximum tracking rate. It is to be understood that the predeterminedrange may vary and is dependent upon the level of safety the programmerrules are implementing into the automatic responsive adjustmentfunction.

It is to be understood that the predetermined range may be set at anyrange necessary for the system to accomplish the automatic responsiveadjustment function. Parameter slide controllers 134 and 140 areautomatically moved to adjust the maximum sensor rate and/or maximumtracking rate thresholds to rates that are consistent with the rules anddo not cause parameter conflicts. In the embodiment illustrated indisplay 100, the maximum sensor rate and/or maximum tracking ratethresholds are adjusted so that the threshold rates are at least 5 Bpmless than the threshold rate of VT-1. If adjustment of the maximumsensor rate and/or maximum tracking rate thresholds downward causes themaximum sensor rate and/or maximum tracking rate thresholds to be withina predetermined range of the lower rate limit, the automatic responsiveadjustment function adjusts the lower rate limit threshold downward. Inthe present embodiment, the predetermined range is 15 Bpm in accordancewith programmer rules that require a range of at least 15 Bpm betweenthe lower rate limit threshold and the thresholds for the maximum sensorrate and maximum tracking rate. It is to be understood that thepredetermined range may vary and is dependent upon the level of safetythe programmer rules are implementing into the automatic responsiveadjustment function.

During movement of parameter slide controllers 122, 126 and 130 toadjust the threshold settings for VT-1, VT and VF, if an attempt is madeto change one of the threshold settings for VT-1, VT and VF to a levelwhere the difference between setting rates of VT-1 and VT and VT and VFhave ranges that are less than minimum ranges set by programmer rulesthat control engagement of the automatic responsive adjustment feature,the automatic responsive adjustment feature engages. In the presentembodiment, the minimum ranges set for difference between the thresholdsetting rates of VT-1 and VT and VT and VF is 20 beats per minute (Bpm).The automatic adjustment feature engages upon the adjustment ofthreshold settings for VT-1, VT and VF via movement of parameter slidecontrollers 122, 126, 130 vertically upward or downward, when theresulting difference between VT-1 and VT and/or VF and VF is less than20 Bpm.

By way of example, the automatic responsive adjustment feature engagesas a result of the threshold level for VT-1 being increased to a levelthat would cause the difference in threshold levels between VT-1 and VTto be smaller than 20 Bpm. When the automatic responsive adjustmentfeature engages, it causes VF to increase to a level wherein thethreshold level for VF is equal to VT plus the minimum range set byprogram rules. Or, in the present embodiment, VF is equal to the newthreshold level set for VT plus 20 Bpm. In addition, the automaticresponsive adjustment feature engages as a result of the threshold levelfor VF being lowered to a level that would cause the difference inthreshold levels between VT and VF to be smaller than the minimum rangeset by programmer rules that control engagement of the responsiveadjustment feature (20 Bpm). When the automatic responsive adjustmentfeature engages, it causes VT to be automatically lowered to a levelwherein the threshold level for VT is 20 Bpm lower than the newthreshold level for VF. The automatic responsive adjustment feature alsoengages as a result of the threshold level for VT-1 being increased to alevel that would cause the difference in threshold levels between VT-1and VT to be smaller than the minimum range set by programmer rules thatcontrol engagement of the automatic responsive adjustment feature (20Bpm). When the automatic responsive adjustment feature engages, itcauses VT to increase to a level wherein the threshold level for VT is20 Bpm greater than the new threshold level for VT-1. In addition, theautomatic responsive adjustment feature engages as a result of thethreshold level for VT being lowered to a level that would cause thedifference in threshold levels between VT-1 and VT to be smaller thanthe minimum range set by programmer rules that control engagement of theautomatic responsive adjustment feature (20 Bpm). When the automaticresponsive adjustment feature engages, it causes VT-1 to beautomatically lowered to a level wherein the threshold level for VT-1 is20 Bpm lower than the new threshold level for VT.

The atrial zone illustrated in display 100 is also shown to havethreshold rates defined by a colored window 144 and a parameter slidecontroller 142. Colored window 144 represents the AF zone. Adjacent tothe edge of colored window 144 is a parameter slide controller 142 thatthe user engages to control the threshold settings for AF. Asillustrated in FIG. 4, the threshold rate for AF, as illustrated in therate window of parameter slide controller 142, is 170 Bpm. The AFthreshold may be modified by moving the parameter slide controller 142upward to increase the threshold level and downward to decrease thethreshold level. If the parameter slide controller 142 is adjusted bythe system user and the resulting threshold rate of AF is reduced to athreshold rate that is within a predetermined range of the maximumsensor rate or maximum tracking rate thresholds displayed, the automaticresponsive adjustment feature engages and causes automatic adjustment ofthe maximum sensor rate and/or maximum tracking rate via parameterslider controllers 134 and 140 so that the AF threshold rate remains atleast at a predefined level as defined by program rules higher than themaximum sensor rate and maximum tracking rate. In the presentembodiment, the predetermined range is 5 Bpm, and in accordance withprogrammer rules there is a required range of at least 5 Bpm between theresulting threshold rate of AF and the resulting maximum sensor rate andmaximum tracking rate. Parameter slide controllers 134 and 140 areautomatically moved to adjust the maximum sensor rate and/or maximumtracking rate thresholds to rates that are consistent with the rules soas to prevent parameter conflicts. In the embodiment illustrated indisplay 100, the maximum sensor rate and/or maximum tracking ratethresholds are automatically adjusted downward so that the thresholdrates are at defined level less than the threshold rate of AF. In thepresent embodiment, the maximum sensor rate and/or maximum tracking ratethresholds are automatically adjusted downward so that the thresholdrates are at least 5 Bpm less than the threshold rate of AF. Ifadjustment of the maximum sensor rate and/or maximum tracking ratethresholds downward via movement of parameter slide controllers 134 and140 or adjustment of the lower rate limit upward via movement ofparameter slide controller 136 causes the maximum sensor rate and/ormaximum tracking rate thresholds to be within a range defined byprogrammer rules of the lower rate limit threshold rate, the automaticprogramming function adjusts the lower rate limit threshold downward orthe maximum sensor rate and maximum tracking rate upward, maintaining athreshold range in accordance with the range defined by the programmerrules between the lower rate limit and the maximum sensor rate andmaximum tracking rate. In this embodiment the range set by programmerrules is 15 Bpm. The programmer rules require a range of at least 15 Bpmbetween the lower rate limit threshold and the thresholds for themaximum sensor rate and maximum tracking rate.

When the AF threshold level is increased, the size of colored window 144becomes smaller. When the AF threshold level is decreased, the size ofthe colored window 144 becomes larger. The graphical user interface 100further allows the number of atrial zones to also be modified andselectively toggled between single zone and dual zones. The presentembodiment is a single zone atrial configuration that includes an AFzone only. Alternatively, engaging interactive atrial zone button 118allows for the selection of two alternative dual zone sets. A firstatrial zone set being comprised of AF and AT and a second atrial zoneset being comprised of AF Rhythm and AT.

The graphical user interface 100 also provides rate grabbers for Bradythreshold rates for the ventricle and atrial zones. The Brady thresholdrates are comprised of the maximum sensor rate, maximum tracking rateand lower rate limit. The maximum sensor rate, illustrated by a firstedge of the maximum sensor rate colored window 132, has a parameterslide controller 134 adjacent the first edge. The parameter slidecontroller 134 includes a rate window that also illustrates a maximumsensor threshold rate. The threshold rate illustrated within the ratewindow of parameter slide controller 134 may be the rate currentlyprogrammed in the medical device, if the background of the rate windowis white, or it would reflect a new threshold that has not betransmitted to the medical device if the background of the rate windowis green. It is to be understood that the feature of changing thebackground of the rate window of parameter slide controllers applies toall slide controllers of this invention, and is not to be limited bycolors being used. The concept of advising the user as to whether theparameter illustrated in the rate window is already programmed in themedical device or one that may be programmed in the feature or of theimportant features. The maximum tracking rate 140, illustrated by afirst edge of the colored window 138, has a parameter slide controller140 adjacent the first edge. The parameter slide controller 140 includesa rate window that also illustrates a maximum tracking threshold rate.The lower rate limit is illustrated by a parameter slide controller 136that is adjacent a second edge of the maximum sensor rate colored window132 and a second edge of the maximum tracking rate colored window 138.The Brady threshold upper rate limit is the higher threshold rate of themaximum sensor rate and maximum tracking rate, reflected in the firstedge or in the rate window of parameter slide controllers 134 and 140.

As illustrated in FIG. 4, the maximum sensor rate 132 and the maximumtracking rate 138 are both 120 Bpm. Both the maximum sensor rate 132 andthe maximum tracking rate 138 may be increased or decreased by slidingthe parameter slide controllers 134 and 140 vertically upward ordownward. The programmer rules that control engagement of the automaticresponsive adjustment feature governs interaction of maximum sensor rate132 and maximum tracking rate 138 and controls the range within whichthe maximum sensor rate 132 and maximum tracking rate 138 may beadjusted. In this embodiment, the maximum sensor rate 132 may beincreased or decreased by sliding the parameter slide controller 134vertically upward or downward until it reaches a maximum or minimumdefined by program rules. In this embodiment, the maximum sensor ratemay be increased up to a point at which the threshold rate is at least 5Bpm less than VT-1 (125 Bpm) or, in the present embodiment 120 Bpm.Accordingly, in the embodiment illustrated in FIG. 4, the maximum sensorrate parameter slide controller 134 may not be adjusted upward toincrease the maximum sensor rate as it is already at its highest levelpossible within the program rules. The automatic responsive adjustmentfeature, in accordance with the rules, will not allow the maximum sensorrate to be increased because an increase of the maximum sensor rate to athreshold rate that is within 5 BP of the threshold rate of VT-1 wouldcause parameter conflicts. To prevent such conflicts, the automaticresponsive adjustment feature prevents such an adjustment.Notwithstanding, in an alternative embodiment, wherein the thresholdrate of VT-1 has been removed from the display and only two zones VT andVF are illustrated in display 100, the maximum sensor rate could beincreased via slider 134 up to 140 Bpm. Upon the maximum sensor ratereaching 140 Bpm, the parameter control slider 134 is not allowed tomove upward any further. Under no circumstance does the automaticresponsive adjustment feature allow an increase of the maximum sensorrate to adjust the threshold rates of VF, VT and VT-1. The maximumsensor rate may only be increased to a threshold rate that is at least 5Bpm less than the smaller of the threshold rates for VF, VT and VT-1.The maximum sensor rate may be decreased to a minimum level set byprogram rules by moving the parameter slide controller 134 downward.

Similar to the maximum sensor rate, the maximum tracking rate 138 mayalso be increased or decreased by sliding the parameter slide controller140 vertically upward or downward. In this embodiment, the maximumtracking rate may be increased up to a point at which the threshold rateis at least 5 Bpm less than VT-1 (125 Bpm) or, in the present embodiment120 Bpm. Accordingly, in the embodiment illustrated in FIG. 4, themaximum tracking rate parameter slide controller 140 may not be adjustedupward to increase the maximum sensor rate as it is already at itshighest level possible within the rules. The automatic responsiveadjustment feature, in accordance with the rules, will not allow themaximum tracking rate to be increased because an increase of the maximumtracking rate to a rate that is within 5 Bpm of the threshold rate ofVT-1 would cause parameter conflicts. To prevent such conflicts, theautomatic responsive adjustment feature prevents such an adjustment.Notwithstanding, in an alternative embodiment, wherein the thresholdrate of VT-1 has been removed from the display and only two zones VT andVF are illustrated in display 100, the maximum tracking rate could beincreased via slider 140 up to 140 Bpm. Upon the maximum tracking ratereaching 140 Bpm, the parameter control slider 140 is not allowed tomove upward any further. Under no circumstance does the automaticresponsive adjustment feature allow an increase of the maximum trackingrate to adjust the threshold rates of VF, VT and VT-1. The maximumtracking rate may only be increased to a threshold rate that is at least5 Bpm less than the smaller of the threshold rates for VF, VT and VT-1.The maximum tracking rate may be decreased to a minimum level set byprogram rules by moving the parameter slide controller 140 downward.

In the embodiment illustrated in display 100, the maximum sensor rateand maximum tracking rate colored windows 132 and 138 may decreased bysliding lower rate limit parameter slide controller 136 upward until thelower rate limit reaches 105 Bpm. This reflects that the maximum sensorrate and maximum tracking rate range colored windows 132 and 138 areonly 15 Bpm each. The programmer rules require a range of at least 15Bpm between the lower rate limit threshold and the thresholds for themaximum sensor rate and maximum tracking rate. Accordingly, in theembodiment illustrated in FIG. 4, the lower rate limit parameter slidecontroller 136 may not be adjusted upward to increase the lower ratelimit threshold as it is already at its highest level possible withinthe rules. The automatic responsive adjustment feature, in accordancewith the rules, will not allow the lower rate limit threshold to beincreased because an increase of the lower rate limit threshold to athreshold rate that is less than 15 Bpm would cause parameter conflicts.To prevent such conflicts, the automatic responsive adjustment featureprevents such an adjustment. Notwithstanding, in an alternativeembodiment, wherein the threshold rate of VT-1 has been removed from thedisplay and only two zones VT and VF are illustrated in display 100, thelower rate limit threshold could be increased via parameter controlslider 136 up to 125 Bpm. Moving of lower rate limit parameter controlslider 136 up to 125 Bpm causes the automatic responsive adjustmentfeature to automatically adjust the maximum sensor rate and maximumtracking rate thresholds upward via automatic movement of the maximumsensor rate and maximum tracking rate parameter slide controllers 134and 140. Upon the maximum sensor rate and maximum tracking rate reachingthreshold rates of 140 Bpm, the parameter control sliders 134 and 140are not allowed to move upward any further. Under no circumstance doesthe automatic responsive adjustment feature allow an increase of themaximum tracking rate to adjust the threshold rates of VF, VT and VT-1.The maximum tracking rate may only be increased to a threshold rate thatis at least 5 Bpm less than the smaller of the threshold rates for VF,VT and VT-1. The maximum tracking rate may be decreased to a minimumlevel set by program rules by moving the parameter slide controller 140downward.

Display 100 includes colored display windows 120, 124, 128, 132, 138,144, that are comprised of at least three distinct colors, one color forthe atrial, one for the ventricle and one for Brady. In the presentembodiment, the colored display windows 120, 124, and 128 for ventriclezones VF, VT and VT-1 are comprised of different shades of a color toreflect that there are three separate and discreet zones in theventricle. In an alternative embodiment in which the Atrial Zone iscomprised of two zones, AF and AT, AF and AT are comprised of differentshades of a color to reflect that there are two separate and discreetzones.

On the right-hand side of display 100, therapy summary areas forventricular tachy therapy, atrial tachy therapy and Brady therapy areillustrated in summary areas 171, 173 and 175. Ventricular tachy summaryarea 171 displays the patient scheme, mode and rate for each of thethree zones VF, VT and VT-1 at 150, 152 and 154. Additional ventriculartachy parameter settings may be viewed and changed by selecting thedetection or therapy buttons 156 and 158.

Atrial tachy summary area 173 illustrates the pacing mode and rateswithin the atrial zones. In the embodiment illustrated in display 100,the atrial tachy therapy summary illustrates the pacing modes and rateswithin the atrial zones 141, 143 and 145. Additional atrial tachyparameter settings may be viewed and changed by selecting the detectionmanagement button 160, therapy management button 162 or arrhythmiamanagement button 164. The Brady therapy summary area 175 illustratesthe normal and post-shock Brady cardio modes, rates, and outputs 180,182 and 184. Additional Brady cardio parameters settings may be viewedand changed by selecting the Brady cardio normal settings button 170,the post shock settings button 172, and the timing cycles button 174.

In the embodiment shown in FIG. 4, the ECG display 110, 112 and 114 isalways visible. The ECG display 110, 112, 114 shows real time surfaceECG traces, as well as real-time electro grams, which are useful inascertaining system performance.

In one embodiment, real-time electro grams can be transmitted from thepace/sense or shocking electrodes to evaluate lead system integrity suchas lead fractures, insulation breaks, or dislodgments.

As illustrated in FIG. 4, the graphical user interface display 100illustrates the threshold settings in beats per minute in accordancewith the scale positioned in proximity to the colored windows 120, 124,and 128 and parameter slide controllers slide controllers 122, 126, 130,142, 134, 140, and 136 along the left side of graphical user interface100. The scale along the left side of graphical user interface 100 maybe modified and illustrated in time as milliseconds by engaging thescale modification button 135. Engaging the scale modification buttonalso changes the values inside the slide controller windows to bereflective of intervals instead of rate. FIG. 4A illustrates display 100wherein the scale modification button 135 has been engaged and thevalues inside the slide controller windows are reflective of intervals.

Interface for Setting, Adjusting and Visualizing Device Timing Behavior

In order to understand and analyze a cardiac cycle in a heart, it iscommon to break the cardiac cycle down into its composite parts. Display400 assists in the understanding of the cardiac cycles of the heart byillustrating the respective timing intervals of the cardiac cycle andhow the timing intervals interrelate with each other.

Referring to FIGS. 5 and 6, is another illustration of a graphical userinterface display 400 wherein the programmer utilizes the automaticresponsive adjustment feature. Display 400 is used for setting,adjusting and graphically visualizing device timing behavior and therelationship between different timing parameters. It also preventscertain timing behavior in an implantable medical device from being setto an unsafe or undesirable condition. It also provides the programmeruser with the ability to graphically communicate how cardiac conditionsrelate to particular parameters as the user adjusts parameters such asAtrioventricular delay (AV delay), left ventricular offset (LV offset),post-ventricular atrial refractory period (PVARP) right ventricularrefractory period (RVRP), and left ventricular refractory period (LVRP).It also allows the programmer user to graphically resolve potentiallyunsafe conditions and undesirable states resulting from the adjustmentof parameters. It further allows the user to visualize the graphicrelationship between timing parameters such as AV delay, LV offset,PVARP, RVRP and LVRP while facilitating the user's ability tographically adjust the atrial and ventricular timing settings usingparameter control sliders. When the timing parameters are adjusted bythe parameter slide controllers, the timing behavior including sensingwindows and blanking periods will also be graphically displayed. Display400 also uses color codes to illustrate the relationship betweendifferent atrial and ventricular timing settings and the status of thecertain parameter changes. With certain parameter changes, the change isillustrated with a green background because it is a safe. Otherparameter changes are illustrated with a yellow background to illustratethat the proposed change are undesirable and with a red background toillustrate that the proposed changes are unsafe. Yellow is to warn theuser and red is to indicate that an error will occur if an attempt ismade to program the parameters illustrated. Under these circumstances,the programmer automatically indicates recommended changes to overcomethe undesirable or unsafe conditions.

Display 400 includes an AV delay area 401, an LV offset area 410, aPVARP display area 420, an RVRP display area 430 and an LVRP displayarea 440. Each display area, including LV delay area 401, an LV offsetarea 410, an PVARP display area 420, an RVRP display area 430 and anLVRP display area 440, illustrates timing settings and includesparameter slide controllers for adjusting the timing settingsgraphically. The AV display area 401 illustrates the timing settingassociated with the AV delay timing interval and includes a graphicaluser interface for adjusting the minimum and maximum values for AVdelay. Although not to scale, it also includes a graphicalrepresentation of the AV delay timing cycle in relation to the LVoffset, PVARP, RVRP and LVRP timing settings. The adjustments to AVdelay are accomplished by movement of parameter slide controllers 402and 403 to the appropriate timing settings. The adjusted or programmedparameters of the AV delay are illustrated in the parameter slidecontroller rate windows 404 and 405.

The atrial pulse indicator line 510 illustrates the beginning of the AVdelay period, which ends at the Right Ventricular Pulse (RVP) indicatorline 520. The graphical representation of the AV delay timing cycle isfurther reflected in the adjustment guide 407 which is a graphicaldisplay of the AV delay timing cycle shown in relation to the timingcycles for, LV offset, PVARP, RVRP and LVRP. When it is desired toadjust the minimum and/or maximum rates for the AV delay, parameterslide controllers 402 and 403 are moved horizontally along theadjustment guide 407. Movement of parameter slide controllers 402 and403 causes the parameters illustrated within the parameter slidecontroller rate windows 404 and 405 to be adjusted. Movement ofparameter slide controller 403 also causes the movement of the RightVentricular Pulse (RVP) indicator line 520. The RVP indicator line 520is representative of the beginning of the right side of the timinginterval. It may be reflective of a sensed ventricular event (R wave) ora ventricular pace.

It can be seen in display 400 that the AV delay minimum illustrated inthe parameter slide controller rate window 404 in display 400 is 10milliseconds. The AV delay maximum has been adjusted to 300 millisecondsby movement of parameter slide controller 403. The user is automaticallyadvised that the 300 milliseconds illustrated in the parameter slidecontroller rate window 405 is not the AV delay maximum parameter that isprogrammed into the medical device because the background of the ratewindow 405 is green. Whenever the user of the programmer's graphicaluser interface adjusts parameters within the parameter slidecontrollers, the background of the parameter slide controller ratewindow changes to another color. In the present embodiment, thebackground is white when the parameter within the parameter slidecontroller rate window reflects the value previously programmed to themedical device. The background is green when the parameter within theparameter slide controller rate window is a non-conflicting parameterthat has not been programmed to the medical device. The background isred when the parameter within the parameter slide controller rate windowis a conflicting parameter with another parameter. In instances wherethe parameter slide controller rate window displays a parameter thatconflicts with other parameters and thereby may cause an unsafecondition, the program rules prevent the transmission of such aparameter to the medical device. As illustrated in FIG. 6, display 400also provides the user with the ability to view the changes by engagingthe view changes button 490 and the ability to seek help regarding theconflicting parameters by engaging the help button 492.

Regarding the maximum AV delay, the medical device is sensing for a Pwave from the atrial pulse indicator line 510 following the occurrenceof the Atrial pulse 512 up to Right Ventricular Pulse (RVP) indicatorline 520 or for up to 300 milliseconds. If a P wave is sensed prior tocompletion of 300 milliseconds, the sensed ventricular event is used asa basis for all other interval timing. That sensed event acts as thebeginning of the timing intervals for the LV offset, the PVARP, RVRP andLVRP refractory periods, and the overall cardiac cycle intervals whichend at the lower rate limit (LRL). Because all timing is based offventricular to ventricular events, if something is sensed within the AVdelay interval, or in the example illustrated in display 400 within 300milliseconds, then that is the beginning of a new cycle. If aventricular pulse is not sensed within 300 milliseconds, then themedical device will send a pulse to the right ventricle of the heart at300 milliseconds as illustrated by Right Ventricular Pulse (RVP)indicator line 520. Under this circumstance, the Right Ventricular Pulse(RVP) indicator line 520 is used as the base timing for all otherinterval timing because an R wave will not have been sensed within theAV delay timing period or within 300 milliseconds. The minimum AV delay,as illustrated in the AV delay display area 401 is 10 milliseconds. Theminimum AV delay corresponds to the maximum tracking rate (MTR) or themaximum sensor rate (MSR), which is 120 pulses per minute or 500milliseconds. The maximum AV delay corresponds to the lower rate limit(LRL) 60 pulses per minute Ppm or 1000 milliseconds.

The LV offset display area 410 includes an LV offset parameter slidecontroller 413 and an adjustment guide 417 which provides a visualdisplay of the LV offset timing window. The LV offset parameter slidecontroller 413 may be moved horizontally forward and backward toincrease or decrease the LV offset timing window. Upon movement of theLV offset parameter slide controller 413, the LV offset rate adjusts asillustrated in the LV offset parameter slide controller rate window 415.The Left Ventricular Pace (LVP) indicator 530 line is an indication ofthe level at which the pacing in the left chamber needs to be offsetfrom the pacing in the right chamber. Parameter slide controller 413 maybe adjusted to the left of the Right Ventricular Pulse (RVP) indicatorline 520 or to the right of the Right Ventricular Pulse (RVP) indicatorline 520. Movement of slide controller 513 to the left of the RightVentricular Pulse (RVP) indicator line 520 indicates that the LV offsetmay be set for example at negative timing window, for example negative40 milliseconds, which is reflective of the concept that the leftchamber needs to be paced 40 milliseconds before the right chamber.Accordingly, Parameter slide controller 413 can be adjusted to eitherside of Right Ventricular Pulse (RVP) indicator line 520. However,timing shall be based off of the Right Ventricular Pace.

Left Ventricular Pulse (LVP) indicator line 530 is the second edge ofthe LV offset window, which begins at the Right Ventricular Pulse (RVP)indicator line 520 and ends at the Left Ventricular Pulse (LVP)indicator line 530. The actual value of the LV offset in the embodimentillustrated in display 400 is 80 milliseconds. The LV offset value maybe modified or adjusted by sliding parameter slide controller 413 fromthe edge of the Right Ventricular Pulse (RVP) indicator line 520 up to atiming rate allowable within the program rules.

PVARP display area 420 is a post-ventricular atrial refractory period.Refractory periods are defined to make sure that the medical devicedoesn't sense during inappropriate times. If a natural event occurs, forexample, a P wave or an R wave, or the medical device paces, the eventmay have happened in another chamber. However, some of the event may besensed in other chambers and the medical device may believe an event hasoccurred in chambers for which an event has not. When this happens, itis problematic if the medical device reacts to these events. Therefractory period makes sure that the medical device is not over sensingand thereby prevents the sensing of events in chambers that the medicaldevice should be ignoring. Even though the medical device may see anevent from a first chamber in a second chamber as if it occurred in thesecond chamber, the medical device will ignore the first chambers eventduring the refractory period. The chemistry of the heart tissue requiresthat the tissue receive a time of rest (refractory period) after itsqueezes before it can squeeze again. Generally, the heart does notrespond during this period. If the heart is not responding because itphysically cannot, the medical device should not be responding to sensedevents. If the medical device does not ignore those sensed events as theheart does, premature pacing would occur. Refractory periods are periodswhere the medical device sensing is blinded and the medical device willnot pace if it senses an event during the refractory period.

The PVARP refractory period represented by the period from the edge ofthe Right Ventricular Pulse (RVP) indicator line 520 to the edge of theparameter slide controller 523, is not reflected in display 400 toscale. The actual minimum and maximum PVARP refractory periods aredisplayed in the parameter slide controller rate windows 424 and 425 ofparameter slide controllers 422 and 423. The period from the edge of theparameter slide controller 423 to the maximum tracking rate indicator550 is the period during which sensing following the right ventricularpace can occur. The period during which sensing can occur is graphicallyillustrated by changing the background of a portion of adjustment guide427 to an alternative color or texture, represented in display 400 aswhite background with diagonal blue lines drawn there through 429.

The PVARP refractory period is the period that affects sensing in theatrium following a right ventricular pace. Any events that occur withinthe atrium immediately following the Right Ventricular Pulse (RVP)indicator line 520 all the way to the maximum PVARP will be ignored.Alternatively, if the minimum PVARP is used, anything that occursimmediately following the Right Ventricular Pulse (RVP) indicator line520 to the minimum PVARP will be ignored. Whether the system userutilizes the minimum or maximum PVARP is dependent upon whether pacingis occurring at the lower rate limit (LRL) 560 or the maximum trackingrate (MTR) 550. If pacing by the medical device is occurring at thelower rate limit (LRL) 560, anything sensed in the atrium between 0 and250 milliseconds will be ignored. If pacing is based off of the maximumtracking rate (MTR) 550, anything sensed between 0 and 240 millisecondswill be ignored.

RVRP display area 430 is representative of the right ventricularrefractory period. It is comprised of the time that the ventricularsensing on the right side is ignoring events following a rightventricular pace represented by Right Ventricular Pulse (RVP) indicatorline 520. The RVRP display area 430 includes a blanking period 438,parameter slide controllers 432 and 435 and an adjustment guide 437. TheRVRP refractory period represented by the period from the edge of theRight Ventricular Pulse (RVP) indicator line 520 to the edge of theparameter slide controller 435, is not reflected in display 400 toscale. The actual minimum and maximum RVRP refractory periods aredisplayed in the parameter slide controller rate windows 433 and 434 andmay be adjusted by horizontal movement of parameter slide controllers432 and 435. The period from the edge of the parameter slide controller435 to the Maximum Tracking Rate (MTR) indicator 550 is the periodduring which sensing following the right ventricular pace can occur.

The RVRP refractory period is the period that affects sensing in theright ventricle following a right ventricular pace. Any events thatoccur within the right ventricle immediately following the RightVentricular Pulse (RVP) indicator line 520 all the way to the maximumRVRP (represented by the edge of the parameter slide controller 435)will be ignored. Alternatively, if the minimum RVRP (represented by theedge of the parameter slide controller 432) is used, anything thatoccurs immediately following the Right Ventricular Pulse (RVP) indicatorline 520 to the edge of the parameter slide controller 432 will beignored. Whether the system user utilizes the minimum or maximum RVRP isdependent upon whether pacing is occurring at the lower rate limit (LRL)560 or the maximum tracking rate (MTR) 550. If pacing by the medicaldevice is occurring at the lower rate limit (LRL) 560, anything sensedin the atrium between 0 and 250 milliseconds will be ignored. If pacingis based off of the maximum tracking rate (MTR) 550, anything sensedbetween 0 and 240 milliseconds will be ignored.

The left ventricular refractory period (LVRP) display 440 illustratesthe timing that the ventricular sensing in the left ventricle isignoring events following a left ventricular pace represented by LeftVentricle Pulse (LVP) indicator line 530. The LVRP display area 430includes a parameter slide controllers 443 and an adjustment guide 447.The LVRP refractory period represented by the period from the edge ofthe Left Ventricular Pulse (LVP) indicator line 530 to the edge of theparameter slide controller 443, is not reflected in display 400 toscale. The actual LVRP refractory period is displayed in the parameterslide controller rate windows 445 and may be adjusted by horizontalmovement of parameter slide controllers 443.

The left ventricular refractory period, which follows a left ventricularpulse 530, is 250 milliseconds. It begins at the left ventricular pulse530 and ends at the edge of parameter slide controller 443. The actualrefractory period timing parameter is illustrated in the parameter slidecontroller rate window 445. The left ventricular refractory period maybe increased or decreased by sliding parameter slide controller 443horizontally from 0 milliseconds beginning at the left ventricular pace530 out to the maximum tracking rate (MTR) 550.

Display 400 also includes a diagram of a heart 500 that reflects theatrium 502, the right ventricle 504 and the left ventricle 506. Theatrium 502, the right ventricle 504 and the left ventricle 506 are allshaded different colors. In the present embodiment the colors are bluefor the atrium 502, magenta for the right ventricle 504 and orange forthe left ventricle 506. It is to be understood that the colors reflectedin the atrium 502, the right ventricle 504 and the left ventricle 506may be any color so long as the colors are sufficient to identify adistinction between these chambers of the heart. The colored areas ofthe atrium 502, the right ventricle 504 and the left ventricle 506correspond to the adjustment guides 407, 417, 427, 437, and 447 toreflect that for example in the AV delay, the adjustment guide 407relates to delay in the atrium 502. The LV offset adjustment guide 417relates to offset within the right ventricle 504. The refractory periodadjustment guide 427 relates to the refractory period for the PVARP,which is associated with the atrium 502. The refractory periodadjustment guide 437 relates to the refractory period for the RVRP,which is associated with the right ventricle 504, and the refractoryperiod adjustment guide 447 relates to the refractory period for theLVRP, which is associated with the left ventricle 506.

Display 400 also includes a static ECG trace 501 illustrating how therespective components of an ECG trace, including P-wave 512 and the QRSof a R-wave 514. The atrial and ventricular waveforms P-wave 512 and theQRS of a R-wave 514 are adjusted based on timing parameters. Forexample, if the slide controller 403 is adjusted to decrease the maximumAV delay from 300 milliseconds to 250 milliseconds, the distance on theECG trace from the atrial P-wave 512 to the ventricle R-wave 514 wouldalso be decreased. The ECG trace also includes sensing window timingindicators 466 and 468 that illustrate sensing windows for the atrium466 and sensing windows for the ventricle 468. Sensing windows 466 and468 illustrate the beginning and ending of the atrial and ventricularsensing windows in relation to an ECG. Sensing windows 466 and 468 arealso color coded to graphically indicate to the user via display 400that the sensing window 466 relates to the atrium 502 and that thesensing window 468 relates to the right ventricle 504. In the embodimentillustrated in display 400 in FIGS. 5 and 6, sensing window 466 has isblue and sensing window 468 is magenta. It is to be understood that itis contemplated that the ECG trace 501 may not be static and may be anactual ECG trace of a patient illustrated dynamically in display 400.

Display 400 also utilizes the automatic responsive adjustment functionthat automatically illustrates to the user when there are conflictswithin the timing cycle parameters. As illustrated in FIG. 6 of display400, there are conflicts within timing cycle parameters for the AV delayminimum and the PVARP refractory period minimum, as illustrated inparameter slide controller rate windows 404 and 424. Within the AV delaydisplay area 401, the adjustment guide 407 a turns red and hascrosshatches for the portion of the AV delay timing cycle that creates aparameter conflict, if the AV delay minimum parameters are within thatrange. In display 400, if the AV delay minimum, which is 80milliseconds, is reduced to 50 milliseconds, the automatic responseadjustment function would automatically remove the red crosshatchesillustrated in 407 a and 429 a, thereby informing the system userautomatically that the parameters selected are no longer in conflict.

In addition, the background of the timing parameters illustrated inparameter slide controller rate windows 404 and 424 have a redbackground to further indicate to the user which particular timing cycleparameters are in conflict. The system includes a myriad of rules thatdefine circumstances during which modification or adjustments of timingcycle parameters may create conflict between parameters. Upon theadjustment of timing cycle parameters causing parameter conflicts, thered cross hatches would be illustrated on the adjustment guide of theappropriate timing cycle and the background of the parameter slidecontroller rate window would become red to illustrate that theseparticular parameters need to be adjusted. Upon adjustment of thesevalues the red background within the parameter slide controller ratewindow would be changed back to green if it is a non-programmed valueand to white if it the current value that is programmed within themedical device. As illustrated in FIG. 6, the display 400 includes ahelp button 492, which allows the system user to receive additionaldetail concerning the parameter conflicts created by the parameteradjustments made by the user.

It is to be understood that the above description is intended to beillustrative, and not restrictive. For example, the above-describedembodiments may be used in combination with each other. Many otherembodiments will be apparent to those of skill in the art upon reviewingthe above description. The scope of the invention should, therefore, bedetermined with reference to the appended claims, along with the fullscope of equivalents to which such claims are entitled. In the appendedclaims, the terms “including” and “in which” are used as theplain-English equivalents of the respective terms “comprising” and“wherein.”

1. An external programming system for an implantable medical devicecomprising: a communication circuit configured to link to theimplantable medical device to transmit or monitor a timing parametersetting for the implantable medical device; a display device configuredto display, at least one textual representation of the timing parametersetting, at least one textual representation of a specified limit forthe timing parameter setting, at least one graphical slide controlcomprising a movable feature indicating the timing parameter setting, agraphical slide-control limit corresponding to the specified limit forthe timing parameter setting, a graphical representation of physiologicinformation including a portion of said graphical representation alignedwith the slide control movable feature, and a graphical representationof a sensing window aligned with the graphical representation ofphysiologic information; an input device configured to adjust themovable feature in response to a user input; and a processor configuredto monitor adjustment of the timing parameter setting for compliancewith programming rules associated with the implantable medical device,and store an adjusted timing parameter setting in the implantablemedical device.
 2. The system of claim 1 wherein the graphicalrepresentation of physiologic information comprises a representation ofa cardiac timing cycle including at least one atrial event and at leastone ventricular event.
 3. The system of claim 2 wherein the timingparameter setting for the implantable medical device comprises aconfigurable cardiac timing parameter selected from at least one of:Atrioventricular Delay (AVD), Left Ventricular Offset (LVO),Post-Ventricular Atrial Refractory Period (PVARP), Right VentricularRefractory Period (RVRP), or Left Ventricular Refractory Period (LVRP).4. The system of claim 3 wherein a graphical slide control feature isconfigured with a color corresponding to a displayed representation of aportion of a physiologic structure.
 5. The system of claim 1 wherein theprocessor is configured to compare a first timing parameter setting forthe implantable medical device against a second timing parameter settingfor the implantable medical device, and wherein the processor isconfigured to detect when the first timing parameter setting is outsidea range computed using the second timing parameter setting.
 6. Thesystem of claim 5 wherein the display device is configured to change acolor of the textual representation of the timing parameter setting inresponse to the processor detecting when the first timing parametersetting is outside a range computed using the second timing parametersetting.
 7. The system of claim 5 wherein the processor is configured todeliver a warning to a user in response to the processor detecting whenthe first timing parameter setting is outside a range computed using thesecond timing parameter setting.
 8. The system of claim 5 wherein theprocessor is configured to inhibit the communication circuit fromtransferring any timing parameter settings to the implantable medicaldevice in response to detecting when the first timing parameter settingis outside a range computed using the second timing parameter setting.9. The system of claim 5 wherein the display device is configured todisplay an indicator strip including at least one timing parametersetting violation region along a length of the graphical slide control,corresponding to the processor detecting when the first timing parametersetting is outside a range computed using the second timing parametersetting.
 10. A method for programming an implantable medical deviceusing an external programming system, the method comprising: displayingat least one textual representation of a timing parameter settingassociated with the implantable medical device; displaying at least onetextual representation of a specified limit for the timing parametersetting; displaying at least one graphical slide control controlling thetiming parameter setting; adjusting a graphical slide control movablefeature in response to a user input; indicating a proposed change in thetiming parameter setting with the movable feature; limiting a range ofmotion of the graphical slide control movable feature corresponding tothe specified limit for the timing parameter setting; displaying agraphical representation of physiologic information; aligning a portionof said graphical representation with the graphical slide controlmovable feature; displaying a sensing window aligned with the graphicalrepresentation of physiologic information; monitoring the proposedchange in the timing parameter setting for compliance with programmingrules associated with the implantable medical device; and communicatingthe proposed change in the timing parameter setting to the implantablemedical device.
 11. The method of claim 10 wherein displaying agraphical representation of physiologic information includes displayinga representation of a cardiac timing cycle including at least one atrialand at least one ventricular event.
 12. The method of claim 10 whereindisplaying the timing parameter setting includes selecting aconfigurable cardiac timing parameter from at least one of:Atrioventricular Delay (AVD), Left Ventricular Offset (LVO),Post-Ventricular Atrial Refractory Period (PVARP), Right VentricularRefractory Period (RVRP), or Left Ventricular Refractory Period (LVRP).13. The method of claim 10 wherein displaying a graphical slide controlincludes coloring a graphical slide control feature corresponding to adisplayed representation of a portion of a physiologic structure. 14.The method of claim 10 wherein the monitoring includes: comparing thetiming parameter setting against a second timing parameter setting forthe implantable medical device by computing a range based on the secondtiming parameter setting; and detecting when the timing parametersetting is outside the range computed based on the second timingparameter setting.
 15. The method of claim 14 wherein the monitoringfurther includes alerting the user by changing a color of the textualrepresentation of the timing parameter setting and the second timingparameter setting in response to detecting when the timing parametersetting is outside the range computed based on the second timingparameter setting.
 16. The method of claim 14, comprising warning a userin response to detecting when the timing parameter setting is outsidethe range computed based on the second timing parameter setting.
 17. Themethod of claim 14, comprising inhibiting communication of the proposedchange in the timing parameter setting to the implantable medical devicein response to detecting when the timing parameter setting is outsidethe range computed based on the second timing parameter setting.
 18. Themethod of claim 14, comprising: displaying an indicator strip, includingat least one timing parameter setting violation region, along a lengthof the of the graphical slide control; and alerting a user, with avisual indication, when the graphical slide control movable feature isaligned with the timing parameter setting violation region.
 19. Anon-transitory machine-readable storage medium including instructionsthat, when performed by the machine, cause the machine to: display atleast one textual representation of a timing parameter settingassociated with a implantable medical device; display at least onetextual representation of a specified limit for the timing parametersetting; display at least one graphical slide control controlling thetiming parameter setting; adjust a graphical slide control movablefeature in response to a user input; indicate a proposed change in thetiming parameter setting with the movable feature; limit a range ofmotion of the graphical slide control movable feature corresponding tothe specified limit for the timing parameter setting; display agraphical representation of physiologic information; align a portion ofsaid graphical representation with the graphical slide control movablefeature; display a sensing window aligned with the graphicalrepresentation of physiologic information; monitor the proposed changein the timing parameter setting, for compliance with programming rulesassociated with the implantable medical device; and communicate theproposed change in the timing parameter to the implantable medicaldevice.